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Local Doctors Get Big Bucks from Big Pharma

The Troubleshooters team up with investigative newsroom ProPublica to uncover the payments drug companies are making to local doctors, and why some experts believe the money affects patient care. (Published Tuesday, May 21, 2013)

When you get a prescription from your doctor, you probably don't think to ask if he or she is ever on the drug company's dime. But maybe you should.

NBC Connecticut and investigative newsroom ProPublica uncovered millions of dollars that Big Pharma shelled out to local doctors for speaking engagements, meals, and travel. Payments were as large as $200,000 for individual doctors.

"This all has an influence on the health care decisions that are made each day," said Dr. Joseph Ross with the Yale School of Medicine

A database developed by ProPublica reveals the financial relationships between drug companies and doctors. It's not chump change. Connecticut doctors have earned over $28 million from drug companies in the last four years.

Dr. Joseph Ross is an assistant professor at the Yale School of Medicine. He said relationships between pharmaceutical companies and physicians are important--especially when it comes to research. But Dr. Ross said at least some of the money that exchanges hands is a form of marketing.

"That's buying people's time. And that has been shown to have an influence on the decisions physicians make for their patients. It's subtle, it is probably subconscious, but it's influencing their decisions and may be affecting the care of patients,” he said.

One of the top earners in the state by our count is Fairfield neurologist Dr. Peter McAllister. Drug companies Allergan, Eli Lilly, GlaxoSmithKline, Pfizer, Forest and Novartis have all paid him a total of just under a half million dollars since 2009. About $95,000 of that has been for research, but the rest was for meals, speaking engagements, travel and consulting. In a statement Dr. McAllister said,

"The compensation is basically fair market value for expertise and time away from the office. I enjoy teaching and speaking. The compensation doesn't affect patient care. I've done talks for a number of different competing pharmaceutical companies."

Yet critics contend doctors who bring in such high sums are essentially working for the drug companies.

"I don't know how anyone could hold a day job, do all of that speaking, it's not for research purposes. It's just to get out there and talk. Well, that's promotional,” said Dr. Ross.

Dr. Mark Milner made the most money from a single drug company as a private ophthalmologist last year. Allergan paid him up to $200,000 for expert led panels, professional advising, business meals, and travel. He is Allergan's top paid private doctor in the state. We spoke with Dr. Milner by phone. He said he only lectures on drugs he believes in. In a statement, Dr. Milner told us,
“We physicians are bound by a solemn oath to protect our patients. Like most physicians, I abide by this oath and place the interests of my patients above all other concerns. The relationship between healthcare professionals and the pharmaceutical industry is critical to the innovation and development of new medications, devices and treatments. Without this collaborative effort, innovation would be severely crippled.
As a well-known and respected corneal surgeon and specialist in dry eye disease, I lecture around the world for industry and hospitals to educate other physicians about therapies to help their patients with this chronic disease. I pride myself on giving lectures that are fair, balanced, unbiased and on label. I am certain the information I provide about the advantages and disadvantages of these treatments, based upon my extensive experience, is extremely helpful to the physicians in attendance and their patients. I am compensated for my experience, knowledge and time, and for nothing else. As with the majority of key opinion leaders and experts who lecture, at no time are my practice patterns ever compromised.”
Experts like Dr. Ross said while physicians may think the money doesn't matter, evidence shows otherwise.

"Decades of research have shown that these payments and other promotional marketing objectives from the companies are effective at influencing prescribing behavior,” said Dr. Ross.

Taxpayer dollars may be at stake. In 2010 and 2011, state records show Dr. Michael Brennan of Fairfield was the state's top Medicaid prescriber of pain medicine Actiq. Two years ago he wrote more than double the amount of Actiq prescriptions than the next highest prescriber. Over the course of 4 years drug company Cephalon, maker of Actiq, paid him $50,000 in speaking, consulting, and travel. Dr. Brennan said he's prescribed Actiq "in relatively infrequent cases,” and in a written statement told the Troubleshooters,

First, I will put forth that all of the professional societies of which I am a current or former member, (AMA, CT Medical society, Fairfield County Medical Society, American Academy of Physical Medicine and Rehabilitation, The American Pain Society, The American Academy of Pain Medicine) have positions that do not prohibit such relationships. Rather, all interactions should at their heart have patient’s best interest at heart.
Second, the Connecticut State Medical Department of Public Health does not prohibit these types of relationships.

First, concerning Actiq. In the case of cancer patients, like other physicians similar to me, I will help or assume pain care for patients in need of my type of expertise. Often, the best medicine for the pain most afflicting cancer patients-known as breakthrough pain- is best managed by a drug that targets this type of pain. In relatively infrequent cases, I have prescribed Actiq. As data suggests I have on average prescribed 114 prescriptions of Actiq in the last couple of years. That averages less than 10 prescriptions per month, in a practice following between 900 and 1000 patients. This is used sparingly, in patients who fail other approaches. (as I mentioned, under treatment of cancer pain has been described in countless articles and to me is a great shame and indictment of physicians responsibility)[i]
I have spoken for TEVA/Cephalon. I have given a number of talks over the years, and I have been paid what their attorneys say is ‘fair market value’, a dictum of the FDA. Why am I asked, I can only assume is because I do a reasonable job. The fees are determined not by me, but by the pharmaceutical company. The role of these talks in my mind has always been educate, educate and educate. A recent report by the Institute of Medicine has pointed out the scope of under treatment. [ii] I have also served as a consultant for them in developing tools to help reduce the risk of these medicines, known as TIRF REMS. In fact, the majority of payments from TEVA are likely for those activities.
As I told you, I have a ‘practice of last resort’. I am often the 6,7,8th physician seen. Many patients locally-as well as nationally- are relegated to under treatment. As noted in the IOM report, doctors are in need of education. I see my role as a community based educator. If I can educate physicians I will, whether in a conference hall like last weekend speaking to Nurses and PA’s or at restaurants. The effort I make is always the same: recognize under treatment, assess patients thoroughly and treat as you would wish to be treated.
As Dr. Brennan wrote, relationships with drug companies such as these do not violate any professional or legal standards.

Former drug company reps like Len LaBonia, now a professor at Quinnipiac, said the financial relationship between doctors and Pharma is misunderstood.

"By and large, the vast majority of practices that go on are well within guidelines that the FDA and the pharmaceutical industry have developed and continue to support,” he said.

Still critics say patients shouldn't have to worry their doctors are being influenced by anything other the best possible care options that are out there.

“Why do we have to have these little bits of money floating around the system when we know they're probably influencing decisions and making it less likely that the patients are going to believe in their physicians? It just erodes the entire public trust in the profession and that's why they need to go,” said Yale’s Dr. Ross.